Tens of thousands of nurses and nearly 12,000 ambulance workers went on strike Monday over pay and working conditions in the biggest walkout in the 75-year history of Britain’s National Health Service (NHS). Escalating industrial action comes after years of falling wages, stretched budgets and staff shortages that have left the NHS in a state of crisis, with waiting times for treatment at a record high. At the same time, an aging population needs its services more than ever. That unhappy mix is fueling a boom in demand for private health care from a much broader swathe of the UK population than ever before — a fundamental shift for a nation with one of the world’s best-known universal health systems. “Our providers are telling us that people are going private, many for the first time, and the key factor driving that is the challenge in accessing NHS care,” said David Furness, policy director at the Independent Healthcare Providers Network, an industry body for private healthcare companies. At the end of November, a record 7.2 million patients in England were waiting for non-urgent medical treatment on the NHS, known as “elective” care. This spans diagnostic tests and scans, procedures such as hip and knee replacements, but also cardiac surgery, cancer treatment and neurosurgery. More than half of those on the list had been waiting up to 18 weeks and about 400,000 patients had been waiting more than a year, according to data from NHS England. To avoid joining a waiting list, more and more people are paying for their own private medical care or taking out health insurance. In the second quarter of 2022, the number of patients paying directly for private hospital care increased 34% compared with the same period in 2019 to reach 67,000, according to the Private Healthcare Information Network, which collects data on UK private healthcare. The figures revealed a 184% jump in the number of people paying privately for hip replacements over that period, a 153% increase in self-pay for knee replacements and a 42% rise in private cataract surgery. Private hospital groups flourish To keep up with growing demand for their services, private health care providers are expanding at a rapid clip. US group Cleveland Clinic plans to open its third UK facility in London later this year, adding to the 184-bed hospital and the six-floor clinic it opened in the capital city in 2021 and 2022 respectively. HCA Healthcare\n \n (HCA), another American group, which has over 30 facilities in London and Manchester, will be opening a £100 million ($120 million) private hospital in Birmingham — the second biggest UK city — later this year. And Spire Healthcare, one of the largest private hospital groups in the United Kingdom, is adding new clinics, theaters and beds around the country as it races to keep up with demand. CEO Justin Ash estimates that the market for private health care in the United Kingdom has doubled since before the pandemic to 15 million people. “Our biggest single challenge is how do we treat the numbers of patients coming towards us,” he told CNN. The group plans to develop two new clinics in 2023, which are quicker to build than hospitals and are designed for procedures that don’t require overnight stays — for example, those in ophthalmology, gynecology and dermatology. Spire is also pushing into primary care services, citing demand for face-to-face appointments with general practitioners. In December, it acquired The Doctors Clinic Group, a network of 22 private GP clinics with a strong presence in central London. Ash said that appetite for private health care spans a much broader set of ages and incomes than in the past. “This is not the super-rich. This is ordinary people who are choosing to go private, and that is a shift,” he said. Health insurance on the rise One such patient is Emma Freeth, a website administrator. She decided to take out private medical insurance after waiting nine months to see a specialist on the NHS. “That’s what really triggered it: the idea that I just want to be able to get the help when I need it, rather than having to wait and wait and wait,” she told CNN. “If I was in pain or discomfort this would be a real problem,” she said of her thoughts at the time. In November, Freeth, 58, and her 55-year-old husband Peter, a photographer, took out medical insurance in their personal capacity for the first time in their lives. Their story is mirrored in data from health insurers. Bupa added 150,000 new UK health insurance customers in 2022, while rival VitalityHealth has seen a 20% rise in customers over the past year to more than 900,000. “We expect the growth we have seen in health insurance uptake to continue in 2023,” said Neville Koopowitz, CEO of Vitality UK. “This is because people are undoubtedly turning to private healthcare to ensure they have access to high-quality care, quickly, if they were to get ill,” he added. The Freeths, who are self-employed, said minimizing time off work with ill health was a major factor in their decision making, particularly given long wait times for appointments on the NHS. According to the Office for National Statistics, record numbers of Brits are leaving the workforce due to long-term sickness, a problem it partly ascribes to long wait times for NHS treatment. This is an issue of growing concern to employers. Recent polling by Savanta of more than 1,000 businesses on behalf of the Independent Healthcare Providers Network found that over half are worried that rising NHS waiting times may result in employees taking long absences or permanently leaving work due to sickness. And one in five said they were considering offering private medical insurance to their employees in the coming year. A two-tier health system? With the NHS estimating that it will take years for wait times to fall, the demand for private health care in Britain is set to keep growing. Longer-term, there are questions about whether the NHS is sustainable in its current form, offering comprehensive free health care to all funded purely by taxes, particularly against the backdrop of an aging population and strained government finances. The NHS is already the largest single item of public expenditure in Britain, according to the Office for Budget Responsibility, with ONS figures showing that healthcare spending amounts to around 12% of GDP. Some experts worry that moving away from a universal NHS would lead to a two-tier health system where people with means pay for private care, enabling them to go back to work and resume normal life more quickly than those who are less well-off and forced to rely on constrained public services. “The risk is less a sudden privatization and more an emergence of something resembling the English education system — where the very best education is so often conditional on ability to pay,” researchers at the Institute for Public Policy Research, a think tank, wrote in a report last year. “If this were to become the new normal… it would worsen overall health and widen inequality,” they added. But Ash of Spire Healthcare has a less dystopian view of the future. “We’ve clearly moved into a world in which we’re all NHS patients but have episodes of private care,” he said. That’s “a million miles from a US system,” he added. There is no universal health care in America and most people have private health insurance because health care is very expensive. “There is huge commitment to the NHS. You cannot underestimate that,” Ash said.